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HOWHAZAK)ou5 1.Generator ID Number 2.Page t of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST NOT REQUIRED 1 896-423.EW 40D4D4&= <br /> 5.Generators Name and Mailing Address Generators Site Address[if dlerent than mailing address] <br /> 7-Ehmn 7-EWM SbM No.9201M <br /> P.O.On 711.DOIn TX 75221 4627 Do Wild Dr-SbCldon,CA 9&"207 <br /> Generator's Phone: <br /> S.TransporteV"q <br /> , I U.S.EPA il)Number <br /> U NOT REQUIRED <br /> 7.Transporter 2 Company N me U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> ftft Carwwcftm—PCOMM fllb LwdM <br /> 3878 Parvo Hft LWA,SdM,CA 945% NOT REQUIRED <br /> Facility's Phone: (925)9*9Wl <br /> 9,Waste Shipping Name and Description 10.Containers 11.Total 12.Unit <br /> No, Type Quantity NIt.Nol. <br /> 7. <br /> rr <br /> a Nan lid Wim.Sold 0 0 4 D T 10 Y <br /> +r <br /> 2. <br /> c� <br /> 3. <br /> 4. <br /> 13.Special Handling Instnrttons and Additional Information <br /> So:99-100% Pro1M No: PHLF 204M <br /> Vfter■pprop kft PPE when h■ncng or n nmpdred by be TSDF Pwied w.40M <br /> 14.GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contends of this consignmerd are tuliy and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeieaiNplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Gene ratoes/Offer❑r's PrintedJyped Name SignatureMond D Year <br /> Paiic�r#Actio it an b~of C rxraiar fat c. .1�loCnr►ne C---or— +wt ++� ] [J/ <br /> 15.International Shipments <br /> F ❑Import to U.S. ❑Export From U.S. Port of enlrylexit: <br /> z Tran oder Si nature tore orfs only): Date leaving U.S.: <br /> cc 15,Transporter Acknowledgment of Receipt of Materials <br /> r <br /> TransporterEtMrm) <br /> Na �' SignaW n Day Year <br /> cc ;�ff <br /> O <br /> G. iz <br /> d 2 Transporter 2 Printed/Tyame 5ignalure Month Day Year <br /> 17,Discrepancy <br /> 17a.Discrepancy Indication Space ty ❑Partial Rejection ❑Full Rejection <br /> ❑Quanti ❑Type Ll <br /> Manifest Reference Number: <br /> 171b.Alternate Facility(or Generator) U.S.EPA IO Number <br /> .r <br /> U <br /> w Facility's Phone: <br /> w 17c.Signature of Alternate Facility Ror Generator) Monlh Day Year <br /> E <br /> z <br /> cd <br /> ru <br /> n <br /> 18.Designated Facifiry Owner or Operator:Certificatio rete of materials covered by the manifest except as noted in Item 17a <br /> PrintectTyped Name Signature ❑ ear <br /> 169•BLC-❑5 11977(Rev.5109) DESIGNATED FACILITY TG GENERATOR <br />